Moore, Hazel E
Moore, Hazel E is an individual health care provider with primary practice located at 4536 22Nd Ave , Kenosha WI 53140-5917. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Moore, Hazel E can be contacted via phone (262) 656-0044.Contact Information
Primary practice address
4536 22Nd Ave
Kenosha WI 53140-5917
Phone: (262) 656-0044
Fax: (262) 653-2218
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 3267-015 | Wisconsin |
Profile Details
| NPI number | 1114914066 |
|---|---|
| LBN Legal business name | Moore, Hazel E |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 4th, 2005 |
| Last updated | Dec 29th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114914066 | NPPES |
| Wisconsin | MEDICAID | 33462500 |
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